Dizziness: Causes, Types, and Warning Signs

Dizziness is one of the most common, yet also one of the most general symptoms that lead people to see a doctor, and particularly a neurologist. It is an experience described in many ways: a sense of unsteadiness, lightheadedness, feeling faint, “brain fog,” or the sensation that everything around is spinning. This variety often causes confusion for both patients and their surroundings. However, dizziness is not a diagnosis on its own, but a symptom, and understanding it correctly is crucial for proper management.

First, it is important to clarify what we mean by “dizziness.” In medical practice, we distinguish three main types:

1. Vertigo – the illusion of movement, usually rotational, either of the body itself or of the environment.

2. Unsteadiness – a feeling that the body is not well controlled, particularly while walking; a loss of balance.

3. Pre-syncope – the sensation that the ground is slipping away from under one’s feet, often accompanied by weakness, sweating, or lightheadedness.

An accurate description of the symptom by the patient is the first and most critical step toward a correct diagnosis. Typically, a neurologist is indicated to investigate and treat the first two types of dizziness, vertigo and unsteadiness.

Vertigo is often the result of disorders of the vestibular system, the balance system located in the inner ear and brain. The most common cause is benign paroxysmal positional vertigo (BPPV), which appears as short episodes of intense rotational dizziness when changing positions in bed or bending over. Other causes include Ménière’s disease, vestibular neuritis, and, more rarely, central causes related to the brain. On the other hand, unsteadiness can be caused by problems of the nervous system, vision, muscle strength, or even medication.

When Should Dizziness Be a Concern?

Special attention is required when dizziness is accompanied by other neurological symptoms. Double vision, speech difficulties, weakness in the face or limbs, numbness, severe headache, or loss of consciousness are warning signs that require immediate medical evaluation. In these cases, dizziness may indicate serious conditions, such as stroke or other acute neurological disorders.

A common question among patients is whether dizziness is related to anxiety. Indeed, anxiety and panic attacks can trigger or worsen feelings of dizziness and unsteadiness. However, attributing dizziness solely to anxiety without proper investigation can delay the diagnosis of organic causes. The role of the neurologist is first to rule out physical causes and then, if necessary, collaborate with other specialists.

Another important factor that is often overlooked is medication. Many drugs, including antihypertensives, anxiolytics, antidepressants, or antiepileptics, can cause dizziness, especially at the beginning of treatment or after a dose increase. Metabolic disorders, such as low sodium, anemia, or hypoglycemia, may also present with dizziness and general malaise. For this reason, a complete medical history and appropriate tests are essential.

The evaluation of dizziness relies primarily on a detailed medical history and neurological examination. Modern imaging studies, such as MRI, are used when there are indications of a central cause or atypical features. Not all patients require CT or MRI scans, and unnecessary use often increases anxiety without providing significant benefit.

Patients can play a crucial role in assessing dizziness by observing and recording key details: when it started, its duration, triggers, and whether it is accompanied by nausea, vomiting, hearing loss, headache, or other symptoms. This information is often more useful than any single test.

A particularly valuable tool for patients is awareness of “red flags”, warning signs that should raise concern and prompt immediate medical evaluation. These include:

• Dizziness that appears suddenly and is the most intense the patient has ever experienced

• Dizziness that persists for hours or days without improvement, or progressively worsens

• Dizziness accompanied by severe, unusual, or “different” headache

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Especially when symptoms begin abruptly, without a clear trigger, prompt evaluation by a physician is essential.

Additional Red Flags

Other red flags include dizziness accompanied by neurological symptoms, such as difficulty speaking or swallowing, double vision, sudden loss of vision, weakness or numbness in the face or limbs, coordination problems, unsteadiness with falls, or severe confusion. Special attention is also needed when dizziness is accompanied by loss of consciousness, seizure, fever, or severe neck pain. In these cases, immediate hospital evaluation can be life-saving and should not be delayed.

Conclusion

Dizziness is a symptom with a wide range of possible causes, from simple and benign to serious and urgent conditions. Proper management requires careful patient assessment, clinical experience, and individualized evaluation. The goal is not only to relieve the symptom but to understand and address the underlying cause. If dizziness persists, recurs, or is accompanied by concerning symptoms, an early visit to a neurologist is the safest and most important step.